What follows is the first of a two-part series detailing how staff, physicians and agencies pulled together to respond to the April 6, Humboldt Broncos bus crash.
“There’s been a crash between a bus and a semi.”
That was the call Linda Brothwell got from her nursing supervisor on duty around 5 p.m. on April 6. Brothwell, the facility administrator of Nipawin Hospital, was home at the time. “My initial thought was, ‘I have to get back to the hospital immediately. We’ve got a Code Orange.’”
What Brothwell had been alerted to was a tragedy beyond comprehension -- the collision of a bus carrying the Humboldt Broncos hockey team with a semi-trailer truck approximately 28 kilometres south of Nipawin. Sixteen people were killed and thirteen were injured, some of them critically.
Nipawin, Tisdale and Melfort hospitals were the nearest acute care sites and received the casualties from the crash site first. “My role that night was to co-ordinate the facility’s response and when I got there, staff were already contacting physicians and staff and asking them to return to the hospital,” said Brothwell. “We were already preparing the Emergency Department and the rest of the hospital for incoming patients.”
A Code Orange call initiates a hospital’s emergency response to a large number of incoming casualties. Brothwell said that even though every Code Orange has its own unique and varying factors, the basic emergency preparedness plan outlines what a facility’s response should be in a Code Orange situation.
“The work and priorities change as the needs of the response and events unfold. I’m very proud of the work our rural teams did that night. Our rural facilities were able to respond to a large mass casualty event. We stabilized our patients and got them transported to tertiary (specialized) care in a quick and efficient manner,” she said. “Everyone did what needed to be done to address this unimaginable tragedy that hit so close to home for all of us.”
Take a deep breath, Tracy Farber told herself.
Farber, the facility administrator of Tisdale Hospital, first heard about the accident that night when her husband, a volunteer firefighter, got a call from his fire chief. “His chief said ‘Let Tracy know we will have mass casualties and to get the hospital prepared,’” said Farber.
She headed to the hospital immediately and went into action mode. “With the help of Dr. Tessa Richardson, we started directing staff, setting up supplies and forming teams,” said Farber. “At that point, we had no idea how many victims we would be receiving. We just prepared for the worst.”
Within 30 minutes of Farber getting to the hospital, more than 70 staff had responded to the code and came to the hospital to help. “It really shows how a small community like Tisdale with a rural hospital can come together and support a mass casualty event. The response from staff in all our departments was phenomenal.”
Farber feels that overall everyone knew their role and things ran smoothly. “It was a terribly tragic situation and nothing can really mentally prepare you for the magnitude of something like this,” she said. “But we had our procedures for the Code Orange, and at that point all the emergency preparedness training that you hope you never have to use kicks in. Small rural communities and their facilities are used to working as a team and relying on each other. And that’s exactly what we did.”
David Mandzuk with Saskatchewan Air Ambulance (SAA) was out for supper with his family that night. He got the call around 5:45 p.m.
David Mandzuk with Saskatchewan Air Ambulance.
“My stomach turned inside out to be honest with you,” said Mandzuk. “I used to be a hockey player, I’ve been on those buses and I know what that life is like.” Mandzuk headed to the airport hangar immediately and by the time he got there, at about 6:45 p.m., he already knew they were dealing with a mass casualty situation.
SAA has two fixed wing aircraft in service at all times. “One of our aircraft was just about to land in Edmonton, so we asked them to turn around really quickly once they were done there and we routed them to Nipawin,” said Mandzuk. “Our other plane was here in Saskatoon and shift change was about to happen at 7 p.m. We called our crew in early and got them on route to Tisdale.”
As information continued to pour in, Mandzuk and his crew quickly rounded up other resources, including additional blood and supplies to send on the planes. A third plane at the hangar was down for maintenance but SAA asked Transwest Air, a contracted medi-vac provider out of La Ronge, if they could assist. “Saskatchewan Air Ambulance is responsible for triage of all patients in Saskatchewan that require air transport but Transwest Air performs air transport for lower acuity patients in northern Saskatchewan,” explained Mandzuk. “We work with them all the time and they have primary care paramedics on board. We asked and they were more than willing to help so their plane from La Ronge took off for Nipawin.”
Mandzuk was also able to get help from Alberta Air Ambulance. “They were fantastic to work with,” said Mandzuk. “Within 15 minutes of calling them, they offered us two of their fixed wing critical care capable air ambulances, which we sent to Nipawin.” In the end, SAA transported four patients;
Transwest Air transported one patient; Alberta Air Ambulance transported three patients; and STARS transported four patients, for a total of 12 patient transports that night.
“In a Code Orange event, the biggest challenge can be communicating with all entities,” said Mandzuk. “Were we perfect? No, I don’t think we were, there’s always room for improvement but I can’t even begin to describe how well our team did and how proud I am of everybody including the pilots and how grateful I am to our partners in La Ronge, Alberta and STARS.”
Meanwhile at Royal University Hospital, Heather Miazga, the clinical director on-call for Saskatoon area was arriving at the Emergency Department…
Part two of Responding to the Code Orange Call coming soon.